Age-related macular disease in rural southern Italy
S. Pagliarini, A. Moramarco, R. P. Wormald, B. Piguet, C. Carresi, C. Balacco-Gabrieli, K. S. Sehmi and A. C. Bird
Queen's Medical Center, University Hospital Nottingham, England.
OBJECTIVE: To report the prevalence of age-related maculopathy (ARM) in
Salandra, a small, isolated southern Italian community, to test the
hypothesis that an environmental factor, scarce in such a remote community
but ubiquitous in modern industrial societies, might modify the risk of
developing ARM. DESIGN: Population-based cross-sectional survey. MAIN
OUTCOME MEASURES: Prevalence of advanced age-related macular degeneration
(ARMD) (geographic atrophy or exudative maculopathy) and ARM (large, soft
drusen or retinal pigment epithelium changes, or both) defined by fundus
biomicroscopy and 30 degrees stereoscopic, macular photography.
Self-sustenance was assessed by interview of participants and local shop
retailers. The degree of genetic isolation was computed using a model that
fits the genetic population structure with the frequency distribution of
surnames in the community. RESULTS: A full ophthalmic examination was
undertaken in 366 (63.5%) of 576 eligible participants, 354 (96.7%) of whom
had clinical or photographic assessment for the presence of ARMD and 310
(84.6%) of whom had drusen characteristics graded on color transparencies
for ARM. The overall prevalence of ARMD was 1.1%. Drusen larger than 50
microns and more numerous than 10 were found in 4.5% of subjects. Salandra
was the birthplace of 87.2% of participants and for 77.3% of both parents
of each subject. People in the community tended to consume homegrown
products. CONCLUSION: The prevalence of ARM may be lower in this
self-sustained farming community than elsewhere in the industrialized
world.
